We've all heard the statistics. Obesity is on the rise, and atits current rate, 51% of Americans may be obese by 2030, accordingto an analysis by the National Heart Forum. Medical expensesrelated to obesity could reach $344 billion by 2018, accounting for21% of U.S. healthcare spending.

Several studies have shown that this trend also impacts workers'compensation (WC) costs, as obese workers generally experience moreinjuries and more expensive claims than their non-obesecounterparts.

In this article, we'll review several new, emerging obesityissues that WC professionals must be aware of, as well as proactivestrategies to cope with this growing challenge.

Reclassification as Disease State

In June 2013, the American Medical Association (AMA) House ofDelegates approved a resolution reclassifying obesity as “a diseasestate.” This essentially means 1 out of every 3 Americans (78million adults and 12 million children) suffer from a medicalcondition that requires treatment and interventions. WC costs couldrise significantly as a result.

Obesity as Comorbidity

One effect of the AMA reclassification is more physicians maylook to treat obesity as part of the work injury, arguing that it'srequired for a more successful chance of recovery. These physicianswould cite obesity as a disease on WC medical bills and counselobese claimants on weight reduction prior to a major medicalprocedure, such as surgery.

For example in 2009, the Indiana Workers' Compensation Boarddecided an injured worker was entitled to bariatric surgery as aprecursor to back surgery. The board also decided the claimantshould receive temporary total disability benefits while preparingfor, undergoing, and recovering from both procedures.

Other Comorbidities and Complications

Obese patients often have additional comorbidities, such asdiabetes and high blood pressure, which can slow the healingprocess. For example, a minor ankle fracture experienced by anobese worker with diabetes has the potential to become chronic,complex, and costly.

BMI, the Unreliable Indicator

Obesity has traditionally been assessed through an individual'sbody mass index (BMI), which takes a person's weight and heightinto consideration. A BMI of 25-29.9 is considered overweight and aBMI of 30 or greater is considered obese. Using these parameters,roughly 30% of Americans are estimated to be obese.

However, today, more precise methods of measurement are nowbeing developed, which show that the actual obesity rate might becloser to 60%. This could mean an even greater impact to WC costs.Until these newer, more accurate means of measurement are morewidely adopted, researchers suggest lowering the BMI levels thatindicate obesity—24 for women and 28 for men—to improve accuracyand target the right patients for weight control.

Establish a Weight-Watch System

In order to control obesity's impact on WC claims and costs,employers and WC claims professionals should keep these guidelinesin mind:

• Watch for Weight's Red Flag. Adjusters andnurses should observe the claimant's weight, rather than BMI.Often, 250 pounds is a red flag. If the claimant weighs 250 ormore, claimants may likely have special needs in regards totreatment, recovery, bariatric equipment, and return-to-work (RTW)planning.
• Address Common Injuries. Obese workers areprone to injure their lower extremities, wrist or hand, and back.Common causes of these injuries include falls and lifting. Toreduce these injuries, employers should develop targeted safetytraining that provides all employees with helpful injury-preventionguidelines.
• Check for Comorbidities. Immediately determineif comorbid conditions exist, such as diabetes or osteoarthritis,and whether they may impact the claimant's treatment needs. Obeseclaimants with comorbidities generally require longer recovery andhave increased medical costs. Claims professionals should takethese factors into account when setting reserves.
• Consider Special Needs. Overweight and obesepatients may have special needs, such as bariatric equipment.According to Reuters, a bariatric wheelchair able to hold 500pounds costs $1,056, and a bariatric toilet rated for 700 poundscosts $1,049. Besides equipment, there may be other specializedrequirements, such as modified doses for medication. A 130-poundclaimant would require 295 units of the antibiotic, Cubicin,which costs $590 per dosage, while a 350-pound claimant wouldrequire approximately 800 units, costing $1,600.
• Develop a Proactive RTW Plan. Sinceweight-challenged claimants may miss significant time away fromwork, claims professionals should work with the treating physicianto develop a proactive RTW plan that ensures quality care andcommunication with the claimant regarding the RTWexpectations.
• Stem the Trend with Analysis and Wellness. Thetrue impact of obesity may be hidden from an employer's view.Schedule a time to review claims data to understand the depth andbreadth of obesity-related cost drivers. This can help anorganization design a game plan to address the problem areas.

Today, many employers are committed to preventing injuries andcreating a safe workplace, but they must also integrate wellnessand weight control. There are many initiatives to consider,including walk-at-lunch, bike-to-work, pedometer activity tracking,and “Biggest Loser” challenges. These programs can be effectivewhen using the right incentives and support mechanisms. Employersshould provide education on nutrition and healthier options incafeterias and vending machines. They can also work with insurancecompanies to offer online health-risk assessments, which raiseemployee awareness and get them engaged in improving their ownhealth status.

As waistlines expand and medical costs soar, the strategiesabove can help to proactively address obesity claims, so employerscan minimize the impact on costs. In addition, workplace programshave the potential to control and reduce the obesity trend. Moreimportant than cost savings is the impact employers can have onemployee health and well being.